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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 Cedar St., Everett, WA 98201 425-257-8810 FAX 425-257-8857 www.everettwa.org <br /> SITED €(S. (......./e....lmvY� A v-e� PROPERTY TAX#1 PO( l"J trl 002 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of ibng legal description) <br /> OWNER W i l`�Q,r✓� CI A Qr Phone/E-mail 925-R 925c35 $ <br /> Address 43y, (J�.� (K,Q0j Ave... City/State/Zip tie f W {. 20 <br /> • <br /> APPLICANT: Owner _Owner's Agent Contractor Contractor's Agent _Tenant(must provide a letter of consent from the owner to dp work In the space) <br /> CONTRACTOR OW U41-.) State Lic.# City Bus. Lic.# • <br /> Address • Phone/Email <br /> CONTACT FOR PERMIT <br /> Phone/E-mail • <br /> BUILDING PERMIT APPLICATION CONTRACT PRICE OF WORK <br /> Existing Use of Building HEAT SOURCE: <br /> Proposed Use of Building Gas_ Electric Other <br /> Building type: Single Family _Duplex Townhouse _Multi-Family ^Commercial <br /> Type of project: New _Addition _Remodel _Repair_T.I. Sign Sprinkler Demolition_Change of Use <br /> DESCRIPTION OF WORK(additional space provided on the back): ' <br /> dna 6,1*4-;y- Ae,a_, <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_Addn Alteration_Repair Type of Project: _New_Addn Alteration_-_Repair <br /> Show Number(#)of fixtures Show Number(#)of fixtures <br /> NC—air handling units Toilet <br /> Forced air systems Bathtub <br /> Gas piping I Lavatory(wash basin). <br /> I Water heater I Shower <br /> • I Gas fireplace Kitchen sink&disposal <br /> Gas range Dishwasher <br /> Clothes dryer Clothes washer • <br /> I Range hood Water heater <br /> Exhaust fan I Sink(service/bar/mop/etc.) <br /> Heat pump Backflow preventer(inside bldg) <br /> Unit heater Urinal - <br /> Boiler Drinking Fountain <br /> I Refrigeration Floor drain <br /> I Woodstove Grease trap <br /> I Ducting I Roof drains <br /> Other Medical Gas <br /> SPRINKLER / SUPPRESSION SYSTEM Other: <br /> • <br /> Number of Heads Other: <br /> I hereby certify that I have read and examined this application and know the same to be true and correct.All provisions of laws and ordinances governing this type of work will be complied 1 <br /> with whether specified herein or not.The granting of a permit does not presume to give authority to violate or cancel the provision of any other state or local law regulating construction <br /> That I am autho'zed by the owner of this property to pe the work for which appli tion ism a and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Owtt�rl orrzed Agent Signature Date (Revised 4/2095) <br />